Iida Hiroya, Aihara Tsukasa, Ikuta Shinichi, Yamanaka Naoki
Am Surg. 2017 Nov 1;83(11):1289-1293.
Peritoneovenous shunt (PVS) is used to treat refractory ascites. Here, we identify predictive factors for inhospital death after PVS placement. Thirty-five patients with refractory ascites related to liver cirrhosis and/or hepatocellular carcinoma (HCC) who underwent PVS placement between February 2005 and February 2013 were included in the study. Group A comprised 13 patients for whom the PVS placement outcome was inhospital death. Group B comprised 22 patients who were discharged after PVS placement without complications. Patient background and laboratory data were analyzed to identify risk factors for inhospital death. HCC prevalence in Groups A and B was 92 and 55 per cent, respectively (P = 0.02) and that of portal venous tumor thrombus (PVTT) was 54 and 9 per cent, respectively (P = 0.003). The mean des-γ-carboxy prothrombin (DCP) level in both groups was 15,553 ± 49,330 and 787 ± 2600 mAU/mL, respectively (P = 0.009). Multivariate analysis revealed that the presence of PVTT was the only independent predictor of inhospital death (P = 0.007). The presence of PVTT, HCC, and elevated des-γ-carboxy prothrombin levels are predictors of inhospital death after PVS placement. Therefore, PVS should not be used to treat refractory ascites in patients with these predictors, particularly with PVTT.
腹腔静脉分流术（PVS）用于治疗顽固性腹水。在此，我们确定了PVS置入术后院内死亡的预测因素。本研究纳入了2005年2月至2013年2月间接受PVS置入术的35例与肝硬化和/或肝细胞癌（HCC）相关的顽固性腹水患者。A组包括13例PVS置入术后院内死亡的患者。B组包括22例PVS置入术后无并发症出院的患者。分析患者背景和实验室数据以确定院内死亡的危险因素。A组和B组的HCC患病率分别为92%和55%（P = 0.02），门静脉癌栓（PVTT）的患病率分别为54%和9%（P = 利用多变量分析显示，PVTT的存在是院内死亡的唯一独立预测因素（P = 0..007）。PVTT的存在、HCC以及去γ-羧基凝血酶原水平升高是PVS置入术后院内死亡的预测因素。因此，对于有这些预测因素的患者，尤其是有PVTT的患者，不应使用PVS来治疗顽固性腹水。 003）。两组的平均去γ-羧基凝血酶原（DCP）水平分别为15553±49330和787±2600 mAU/mL（P = 0.009）。多变量分析显示，PVTT的存在是院内死亡的唯一独立预测因素（P = 0.007）。PVTT的存在、HCC以及去γ-羧基凝血酶原水平升高是PVS置入术后院内死亡的预测因素。因此，对于有这些预测因素的患者，尤其是有PVTT的患者，不应使用PVS来治疗顽固性腹水。
